Provider Demographics
NPI:1255673190
Name:WOODY, ROCIO DEL MILAGRO (LCSW)
Entity Type:Individual
Prefix:
First Name:ROCIO
Middle Name:DEL MILAGRO
Last Name:WOODY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3155 PRESIDENTIAL DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30340-3924
Mailing Address - Country:US
Mailing Address - Phone:770-220-2885
Mailing Address - Fax:770-990-1496
Practice Address - Street 1:3155 PRESIDENTIAL DR
Practice Address - Street 2:SUITE 104
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30340-3924
Practice Address - Country:US
Practice Address - Phone:770-220-2885
Practice Address - Fax:770-990-1496
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-18
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0947101YA0400X
GA0048001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)